From Subsidiarity to Better EU Governance: A Practical Reform Agenda for the EU. CEPS Essay No. 10, 8 April 2014

On 23 January 2014, a group of 73 member states’ officials and representatives from the European institutions and academia gathered at Clingendael Park in The Hague for a day-long seminar co-organised by the Netherlands Institute of International Relations and CEPS for the Ministry of Foreign Affairs of the Netherlands. The seminar’s aim was to discuss whether subsidiarity can offer a way forward that reconciles the need for better EU governance with concerns about legitimacy. This paper is based on subsidiarity literature, on preparatory talks with officials from member states and EU institutions and on the discussions in the seminar in The Hague. In particular, the paper explores the political and practical relevance of some of the ideas currently being considered to solidify the principle of subsidiarity in day-to-day decision-making. It maps the current political contours of subsidiarity as they appear in speeches and policy papers and presents some of the main ideas in the current debate on deepening subsidiarity

DRAINFRAME AS A TOOL FOR INTEGRATED STRATEGIC ENVIRONMENTAL ASSESSMENT: LESSONS FROM PRACTICE

ABSTRACT The Drainage Integrated Analytical Framework (DRAINFRAME) was developed by the World Bank's Agriculture and Rural Development Department to look at and act upon agricultural drainage from an integrated natural resources management perspective. The approach has been field-tested in three World Bank-funded projects: an irrigation improvement project in Egypt, a problems and opportunities assessment in relation to Pakistan's national drainage master plan, and a strategic assessment of a public-private partnership project for surface water supply to a desert region in Egypt. The latter study paved the way for a fully fledged environmental and social impact assessment. The cases provide useful lessons on the proper timing of the DRAINFRAME assessment, the role of public participation, and the influence that a proper and timely assessment can have on further development of water resources management plans. The paper links the DRAINFRAME approach to Strategic Environmental Assessment (SEA), an increasingly common tool to assess the potential social, economic and environmental consequences of policies, plans and programmes in an early and more effective manner. Copyright # 2007 John Wiley & Sons, Ltd. RÉ SUMÉ La méthode d'analyse intégrée du drainage (DRAINFRAME) a été développée par le Département Agriculture et Développement Rural de la Banque Mondiale pour examiner et agir sur le drainage agricole du point de vue de la gestion intégrée des ressources naturelles. L'approche a été testée sur le terrain dans trois projets financés par la Banque Mondiale: un projet d'amélioration d'irrigation en Egypte, un bilan-évaluation du programme-cadre national de drainage du Pakistan, et l'évaluation stratégique d'un projet de PPP (partenariat public-privé) pour l'approvisionnement en eau d'une région désertique en Egypte. Cette dernière étude a préparé le terrain pour une étude d'impact environnementale et sociale complète. Les cas étudiés fournissent des leçons utiles sur le moment approprié pour une évaluation par DRAINFRAME, sur le rôle de la participation publique, et sur l'influence qu'une véritable évaluation conduite en temps opportun peut avoir sur le développement ultérieur des plans de gestion des ressources en eau. L'article fait le rapprochement entre DRAINFRAME et l'Evaluation Environnementale Stratégique, un outil de plus en plus courant pour évaluer les conséquences sociales, économiques et environnementales potentielles des politiques, des plans et des programmes de façon suffisamment précoce et efficace

BIOCLAIMS standard diet (BIOsd): a reference diet for nutritional physiology

Experimental replication is fundamental for practicing science. To reduce variability, it is essential to control sources of variation as much as possible. Diet is an important factor that can influence many processes and functional outcomes in studies performed with rodent models. This is especially true for, but not limited to, nutritional studies. To compare functional effects of different nutrients, it is important to use standardized, semi-purified diets. Here, we propose and describe a standard reference diet, the BIOCLAIMS standard diet. The diet is AIN-93 based, but further defined with dietary and experimental requirements taken into account that allow for experiments with bioactive food components and natural (non-expensive) labeling. This diet will be implemented by two European research consortia, Mitofood and BIOCLAIMS, to ensure inter-laboratory comparability

Complicated Odontogenic Infections at 2 District Hospitals in Tonkolili District, Sierra Leone:Protocol for a Prospective Observational Cohort Study (DELAY)

BACKGROUND: Deficits in global oral health care are paramount, and complications of odontogenic infections constitute a considerable global health problem, particularly in low-income countries. A high mortality rate has been observed for patients who have been admitted with complicated odontogenic infections to our facilities in Tonkolili District, Sierra Leone, although exact data have not been published yet. Data regarding who in this region is at risk and why are lacking. OBJECTIVE: The Dental Abscess Study (DELAY) aims to prospectively investigate morbidity and mortality from complicated dental abscesses and to analyze patients’ characteristics and microbial findings to examine predisposing factors for poor outcomes. In particular, the incidence and the clinical and microbial characteristics of complicated odontogenic infections, as well as the sociodemographic data and comorbidities of affected patients, will be studied to develop improved management algorithms based on circumstance-specific factors. METHODS: Patients who present with complicated dental infections requiring hospital admission in Masanga Hospital or Lion Heart Medical Centre will be consecutively selected for possible inclusion in the study (starting on September 4, 2021) over a study period of 1 year, and individual routine follow-ups will be conducted at least 3 months after discharge. The results of standardized questionnaires will be obtained, and clinical measurements as well as medical photos will be taken. Standard laboratory tests (eg, full blood count and HIV status tests) will be performed, and pus specimens will be examined. Local treatment guidelines will be adhered to, and data on medical and surgical treatment as well as data on outcomes will be collected. The study results will be reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. Routine follow-ups will take place at 1 and 3 months postdischarge. RESULTS: The DELAY protocol was endorsed by the Masanga Medical Research Unit’s Scientific Review Committee on June 16, 2021, and ethical approval was granted on July 5, 2021, by the Sierra Leone National Ethics Committee. The funding of the budgeted study costs was approved by Dental Health International Netherlands in August 2021. The projected start date of data collection was September 4, 2021, and the study period will most likely last for 1 year. As such, data collection is expected to be complete in November 2022. CONCLUSIONS: The aim of our prospective observational cohort study is to gain more knowledge about complicated odontogenic infections in Tonkolili District, Sierra Leone, to further improve treatment strategies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/3367

Whole Grain Wheat Consumption Affects Postprandial Inflammatory Response in a Randomized Controlled Trial in Overweight and Obese Adults with Mild Hypercholesterolemia in the Graandioos Study

BACKGROUND: Whole grain wheat (WGW) consumption is associated with health benefits in observational studies. However, WGW randomized controlled trial (RCT) studies show mixed effects. OBJECTIVES: The health impact of WGW consumption was investigated by quantification of the body's resilience, which was defined as the "ability to adapt to a standardized challenge." METHODS: A double-blind RCT was performed with overweight and obese (BMI: 25-35 kg/m2) men (n = 19) and postmenopausal women (n = 31) aged 45-70 y, with mildly elevated plasma total cholesterol (>5 mmol/L), who were randomly assigned to either 12-wk WGW (98 g/d) or refined wheat (RW). Before and after the intervention a standardized mixed-meal challenge was performed. Plasma samples were taken after overnight fasting and postprandially (30, 60, 120, and 240 min). Thirty-one biomarkers were quantified focusing on metabolism, liver, cardiovascular health, and inflammation. Linear mixed-models evaluated fasting compared with postprandial intervention effects. Health space models were used to evaluate intervention effects as composite markers representing resilience of inflammation, liver, and metabolism. RESULTS: Postprandial biomarker changes related to liver showed decreased alanine aminotransferase by WGW (P = 0.03) and increased β-hydroxybutyrate (P = 0.001) response in RW. Postprandial changes related to inflammation showed increased C-reactive protein (P = 0.001), IL-6 (P = 0.02), IL-8 (P = 0.007), and decreased IL-1B (P = 0.0002) in RW and decreased C-reactive protein (P < 0.0001), serum amyloid A (P < 0.0001), IL-8 (P = 0.02), and IL-10 (P < 0.0001) in WGW. Health space visualization demonstrated diminished inflammatory (P < 0.01) and liver resilience (P < 0.01) by RW, whereas liver resilience was rejuvenated by WGW (P < 0.05). CONCLUSIONS: Twelve-week 98 g/d WGW consumption can promote liver and inflammatory resilience in overweight and obese subjects with mildly elevated plasma cholesterol. The health space approach appeared appropriate to evaluate intervention effects as composite markers. This trial was registered at www.clinicaltrials.gov as NCT02385149.</p

Prediction error and myopic shift after intraocular lens implantation in paediatric cataract patients

Aim To determine the amount of myopic shift in children after cataract surgery with intraocular lens (IOL) implantation and to evaluate success in achieving the target refraction. Methods The children were assigned into three groups depending on age at time of surgery: Group A, 0-1 years old; Group B, 1-7 years old; Group C, 7-18 years old. Multiple regression analysis was used to create a formula for expected myopic shift and to find out which variables were associated with a higher absolute prediction error. Results Children less than 12 months of age experienced higher myopic shifts and a larger mean rate of refractive change per year compared with older children. We found higher myopic shifts in younger children at time of surgery and children with unilateral cataract. Absolute prediction error was significantly higher in Group A compared with Groups B and C (p=0.022 and p=0.037, respectively). Multiple regression analysis showed that corneal radius was the only variable significantly associated with absolute prediction error. Conclusion Our data demonstrate the complexity in predicting the postoperative refraction in children under 1 year old and show that age at surgery and laterality are factors to consider when deciding which IOL power to implant in children

Next Generation Health Claims Based on Resilience: The Example of Whole-Grain Wheat

Health claims on foods are a way of informing consumers about the health benefits of a food product. Traditionally, these claims are based on scientific evaluation of markers originating from a pharmacological view on health. About a decade ago, the definition of health has been rephrased to &lsquo;the ability to adapt&rsquo; that opened up the possibility for a next generation of health claims based on a new way of quantifying health by evaluating resilience. Here, we would like to introduce an opportunity for future scientific substantiation of health claims on food products by using whole-grain wheat as an example. Characterization of the individual whole wheat grain food product or whole wheat flour would probably be considered as sufficiently characterized by the European Food Safety Authority, while the food category whole grain is not specific enough. Meta-analysis provides the scientific evidence that long-term whole-grain wheat consumption is beneficial for health, although results from single &lsquo;gold standard&rsquo; efficacy studies are not always straight forward based on classic measurement methods. Future studies may want to underpin the scientific argumentation that long-term whole grain wheat consumption improves resilience, by evaluating the disruption and rate of a selected panel of blood markers in response to a standardized oral protein glucose lipid tolerance test and aggregated into biomarkers with substantiated physiological benefits, to make a next-generation health claim for whole-grain wheat achievable in the near future

Design Issues in Personalized Nutrition Advice Systems

The current health status of the general public can substantially benefit from a healthy diet. Using a personalized approach to initiate healthy dietary behavior seems to be a promising strategy, as individuals differ in terms of health status, subsequent dietary needs, and their desired behavior change support. However, providing personalized advice to a wide audience over a long period is very labor-intensive. This bottleneck can possibly be overcome by digitalizing the process of creating and providing personalized advice. An increasing number of personalized advice systems for different purposes is becoming available in the market, ranging from systems providing advice about just a single parameter to very complex systems that include many variables characterizing each individual situation. Scientific background is often lacking in these systems. In designing a personalized nutrition advice system, many design questions need to be answered, ranging from the required input parameters and accurate measurement methods (sense), type of modeling techniques to be used (reason), and modality in which the personalized advice is provided (act). We have addressed these topics in this viewpoint paper, and we have demonstrated the feasibility of setting up an infrastructure for providing personalized dietary advice based on the experience of 2 practical applications in a real-life setting